Billing Requirements for Physical and Occupational Therapist Assistants

In response to several provider questions, WSI is providing clarification on the billing requirements for a service completed by a Physical Therapist Assistant (PTA) or Occupational Therapist Assistant (OTA). When a PTA/OTA completes a medical service, a provider must:

• Append modifier CQ/CO to the applicable service line item(s)
• Bill with the NPI of the PTA/OTA
• Submit medical notes signed by the PTA/OTA

Reimbursement for a service completed by a PTA/OTA will be at 85% of the WSI Fee Schedule. The reduction applies to both clinic and outpatient hospital bills. Critical access hospitals are not exempt, as WSI does not differentiate between types of hospital types.

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